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Hipaa Sample Forms

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									                                                                                                                Project Sequencing Tool


                                                   Project         Q1 '02               Q2 '02               Q3 '02               Q4 '02               Q1 '03                                                                Q2 '03               Q3 '03                                         Q4 '03
         Initiative                Project
                                                   Number    Jan    Feb     Mar   Apr    May     Jun   Jul    Aug     Sep   Oct    Nov     Dec   Jan    Feb       Mar                                                  Apr    May     Jun   Jul    Aug        Sep                          Oct    Nov     Dec


Sample Initiative 1        Sample Project 1          S1
                           Develop and Maintain
                           HIPAA Program,
                           Organizational
HIPAA Program              Infrastructure, and
Infrastructure             Management Process        A1
                           Determine Overlap of
                           Corporate Compliance,
                           Patient Rights, and
                           Privacy Officers          A2




                                                                                                                                                                        Privacy Compliance Date & Begin TCS* Testing
Organization-Wide Policies Policy and Procedure
and Procedures             Development               B1




                                                                                                                                                              4-16-03




                                                                                                                                                                                                                                                                    TCS* Compliance Date
Site-Specific/Department




                                                                                                                                                                                                                                                         10-16-03
Procedures                 Procedure Development     C1




                                                                                                                                                              4-14-03
                           Authorization
Forms                      Development               D1

                           Notice Development        D2

                           Consent Development       D3
                           Accounting of
                           Disclosures
                           Development               D4
                           Ensure Standard
                           Transactions Captured
                           on Appropriate Forms      D5




*TCS = Transactions & Code Sets                                                                                                     1                                                                                                                                                                           Project Sequencing Tool
                                                                                                                Project Sequencing Tool


                                                   Project         Q1 '02               Q2 '02               Q3 '02               Q4 '02               Q1 '03                                                                  Q2 '03               Q3 '03                                           Q4 '03
        Initiative                Project
                                                   Number    Jan    Feb     Mar   Apr    May     Jun   Jul    Aug     Sep   Oct    Nov     Dec   Jan    Feb             Mar                                              Apr    May     Jun   Jul    Aug              Sep                      Oct    Nov     Dec
                          Organization-wide
                          HIPAA Awareness
Education                 Program                    E1
                          Organization-wide
                          HIPAA Compliant Policy
                          and Procedure Training
                          Program                    E2

                          Site-
                          Specific/Departmental
                          HIPAA Training Program     E3

                          Provider Education         E4




                                                                                                                                                                          Privacy Compliance Date & Begin TCS* Testing
                                                                                                                                                               4-16-03




                                                                                                                                                                                                                                                                        TCS* Compliance Date
                          Payer, Provider and
                          Clearinghouse




                                                                                                                                                                                                                                                           10-16-03
Communication Program     Communication              F1

                          Patient Communication      F2

                          Internal Communication     F3




                                                                                                                                                              4-14-03
Business Associates       Business Associate Log     G1
                          Business Associate
                          Communication and
                          Readiness Assessment       G2
                          Business Associate
                          Contract Development       G3
                          Business Associate
                          Policy and Procedure
                          Development                G4




*TCS = Transactions & Code Sets                                                                                                     2                                                                                                                                                                               Project Sequencing Tool
                                                                                                                  Project Sequencing Tool


                                                     Project         Q1 '02               Q2 '02               Q3 '02               Q4 '02               Q1 '03                                                                  Q2 '03               Q3 '03                                           Q4 '03
          Initiative               Project
                                                     Number    Jan    Feb     Mar   Apr    May     Jun   Jul    Aug     Sep   Oct    Nov     Dec   Jan    Feb             Mar                                              Apr    May     Jun   Jul    Aug              Sep                      Oct    Nov     Dec
HIPAA Standard             Code Set
Transaction and Code Set   Implementation Systems
Implementation             Preparation                 H1
                           Code Set
                           Implementation and
                           Transition                  H2
                           (Name of Application)
                           Upgrade                     H3
                           (Name of Application)
                           Upgrade                     H4




                                                                                                                                                                            Privacy Compliance Date & Begin TCS* Testing
                           (Name of Application)
                           Upgrade                     H5
                           (Name of Application)




                                                                                                                                                                4-16-03
                           Upgrade                     H6
                           (Name of Application)




                                                                                                                                                                                                                                                                          TCS* Compliance Date
                           Upgrade                     H7




                                                                                                                                                                                                                                                             10-16-03
                           Employer Identification
                           Number (EIN)




                                                                                                                                                             4-14-03
Identifiers                Implementation              I1
                           National Provider
                           Identifier (NPI)
                           Implementation              I2




*TCS = Transactions & Code Sets                                                                                                       3                                                                                                                                                                               Project Sequencing Tool
                                                                                                         Project Sequencing Tool


                                            Project         Q1 '02               Q2 '02               Q3 '02               Q4 '02               Q1 '03                                                              Q2 '03               Q3 '03                                           Q4 '03
         Initiative               Project
                                            Number    Jan    Feb     Mar   Apr    May     Jun   Jul    Aug     Sep   Oct    Nov     Dec   Jan    Feb          Mar                                             Apr    May     Jun   Jul    Aug              Sep                      Oct    Nov     Dec


Transition Plan                               J1




                                                                                                                                                               Privacy Compliance Date & Begin TCS* Testing




                                                                                                                                                                                                                                                             TCS* Compliance Date
                                                                                                                                                    4-16-03




                                                                                                                                                                                                                                                10-16-03
                                                                                                                                                    4-14-03
*TCS = Transactions & Code Sets                                                                                              4                                                                                                                                                                           Project Sequencing Tool

								
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